Laser diopexy for peripheral Retinal Ablation in proliferative diabetic retinopathy

To assess the effect and efficacy of the diopexy [contact transscleral retinal photocoagulation with a diode laser] in the peripheral areas of the retina not accessible by standard slit-lamp laser, after full scatter PRP +/- macular treatment in eyes with PDR. The objective is to induce regression of neovascularization in cases with persistent new vessels as an alternative to anterior retinal cryoablation. Diopexy was performed on 35 eyes in patients with PDR associated with NVD +/- NVE's +/- subtotal localized subhyaloid hemorrhage +/- rubeosis irides. Out of the 35 eyes that underwent diopexy, 4 had initial subtotal vitreous hemorrhage, 3 initial rubeosis. In 21/35 eyes stabilization of the neovascularization occurred after diopexy. 7/36 eyes developed vitreous hemorrhage after diopexy [9ms, 3ms, 1 week, 5ms, 2 weeks, 10ms and 3 1/2ms later]. 3 underwent vitrectomy, and in 4 vitreous hemorrhage absorbed, 1/35 eye developed increase in lenticular changes I week after diopexy. Out of the 4 eyes with initial subtotal hemorrhage, 2/4 had recurrent vitreous hemorrhage attacks [1 month and 4 months later], but ultimately vitreous hemorrhage absorbed in all cases within 4 months. Out of the 3 eyes with initial rubeosis, in 2/3 rubeosis regressed 1 week later, and 1/3 rubeosis regressed 1 month later then recurrent rubeosis occurred after another month and later needed vitrectomy for the initial unabsorbed total vitreous hemorrhage. Results showed that diopexy is useful in stabilizing the PDR eyes, help in regression of rubeosis, and in cases of recurrent vitreous hemorrhage, help reabsorption of hemorrhage. Patients with persistent vitreous hemorrhage who underwent vitrectomy later had a better prognosis than those who did not have diopexy. To conclude, diopexy is an intermediate option between laser treatment and vitrectomy in the sequence of PDR treatment

Evaluation of radial optic neurotomy in cases of ischemic central retinal vein occlusion

CRVO remains one of the most challenging medical and surgical disabling retinal vascular disorder owing to the formation of neovascularisation with subsequent neovascular glaucoma and marked deterioration of vision and /or the formation of macular edema which also contributes to marked visual disability. In this study, the benefits and the complications of radial optic neurotomy were studied and evaluated. In this study six eyes of six patients [group 1] underwent pars plana vitrectomy, pan retinal photocoagulation, and intra ocular expansile gas injection and six eyes of six patients had radial optic neurotomy [RON] as an additional step [group 2]. Ocular examination, visual acuity testing and fundus examination were performed pre and post operatively as well as fluorescin angiography and optical coherence tomography [to some patients] to evaluate the effect of RON. No patient suffered neo vascular glaucoma in either group throughout the follow up period which was around 6 months, visual improvement and decreased macular edema by OCT were noticed in both groups but more in the second. Fundus fluorescin angiography showed reduced engorgement of retinal veins as well as decreased macular edema in both groups but more in the second. PPV is safe in ischaemic CRVO. Combined with mild PRP and intraocular gas injection the risk of neovascular glaucoma is low. Neurotomy can be added to improve the chances of recovery of central vision probably through establishing a chorio retinal anastomosis

Evaluation of internal limiting membrane maculorlexis in the management of macular hole

In this study, 12 eyes with full thickness macular holes with ILM peeling [group 1] were compared with another 12 eyes with the same pathology and without ILM peeling. All eyes underwent simple pars plana vitrectomy with [group 1] or without [group 2] ILM peeling with intra-vitreous gas [C3F8] or silicone oil 5000 and face down positioning for 5 days. No adjunctive therapy was used in any group. The closure and/or reopening rate, prognosis, VA and complications in both groups were compared. With good surgical skills and a relatively short follow up period, ILM peeling may not make a difference in retinal reattachment rate; however, it significantly improves the post surgical BCVA